Dear Dr. Roach: I have a carotid artery problem. My right side is 79 per cent blocked, but the left side is clear. My eye doctor said that surgery would not be necessary because the left side could take over if the right side is blocked. My regular doctor will neither confirm nor deny this. I am 85 years old and would like to avoid surgery.
J.L.W.
Although there are connections between the left side and the right (the communicating arteries in the circle of Willis), a significant blockage on one side puts you at risk for a stroke on that side, even if the other side is clear.
In general, surgical treatment is only recommended for people with a life expectancy of at least five years, who have a significant blockage (depending on the guideline, 鈥渟ignificant鈥� ranges from greater than 60 per cent to greater than 80 per cent) and who have access to a centre where the risk of death or stroke from the surgery is less than three per cent. In people who are at high risk from surgery, placing a stent in the carotid artery may be an alternative; however, standard surgery (carotid endarterectomy) is the preferred approach. People with symptoms from the blockage or a history of prior stroke (or a TIA, which is a temporary stroke-like syndrome) are at much higher risk.
The average 85-year-old man has a life expectancy of about six years: Yours may be less or (hopefully) more and depends on your other medical conditions, genetics and lifestyle.
I spent a lot of time trying to get specific information on rates of complications with this surgery from the hospital compare section of the publicly available Medicare database, but I could not get anything more than an overall star rating (1 through 5) for hospitals. I would like exact numbers in order to choose the best hospital in my area. I did find some companies that rated hospitals, but they still did not give me the kind of data I wanted to evaluate hospitals.
Before considering surgery, however, it鈥檚 important to recognize that with optimal medical therapy, your risk of having a stroke is only about one per cent per year. Since you haven鈥檛 told me about any symptoms or prior stroke, surgery might not be the best option for you. Optimal medical therapy consists of quitting smoking (if you do); controlling blood pressure and sugar (if appropriate); eating a healthy diet, such as the Mediterranean diet; getting regular but not overly vigorous exercise; and managing stress.
Dear Dr. Roach: I鈥檓 drinking almond milk and orange juice fortified with calcium and vitamin D to get my daily requirements of these vitamins. Sometimes I use the milk in my instant Cream of Wheat or oatmeal, and wonder if heating these vitamins in the microwave or stovetop destroys their potency.
D.L.
Calcium is very stable and won鈥檛 be damaged by heating, freezing or really anything you do to it. Vitamin D also is relatively stable: Oven-baking foods with vitamin D can destroy about half the vitamin, but brief heating does very little damage to vitamin D.
Other vitamins are not so stable. Vitamin C in particular is very sensitive: Brief cooking or even sitting around on a shelf (such as canned vitamin C-enriched drinks) can degrade most or all the vitamin C. That鈥檚 one of the reasons to eat fresh, raw fruits and vegetables as part of your diet.
Other nutrients are paradoxical: lycopene (a micronutrient found in tomatoes) is concentrated by cooking, so ketchup and tomato sauce and paste are the leading sources of this nutrient in the U.S.
